Hyaluronidase Treatment

Dissolve hyaluronic acid filler with Hyaluronidase

Hyaluronidase for emergencies and unwanted results

Hyaluronidase is an enzyme that has the property of cleaving hyaluronic acid and thus increasing the permeability of connective tissue to fluids. This property has long been exploited in medicine to increase the absorption of local anaesthetics and other drugs administered through the skin. Hylase, which is the trade name of Hyaluronidase in Germany and is frequently used synonymously for Hyaluronidase, is approved for use in ophthalmology; all other applications are so-called “off label use”.

Hyaluronidase after HA-filler treatment

With the increasing popularity of hyaluronic acid (HA) fillers in facial augmentations, artificially produced Hylase is also increasingly used in aesthetic medicine. Namely, whenever there are complications after filler injections or the results of HA-treatments do not meet expectations. In such cases, injected hyaluronic acid can be completely and rapidly redissolved by Hylase. It is therefore no longer possible to imagine HA facial treatments being performed without Hyaluronidase readily available on the spot as an immediate emergency measure. Dissolving HA-filler without Hyaluronidase is not possible.

No HA-filler treatments without Hyaluronidase on hand

As an expert in facial augmentations with hyaluronic acid, Dr. Eva Maria Strobl, has been offering Hyaluronidase treatment since the first day her practice was opened. If only as a precaution, she does not perform HA treatments without having sufficient Hyaluronidase on hand to manage potential complications. But even if patients have had filler treatments elsewhere and are dissatisfied with the results, they are welcome at Dr. Eva Maria Strobl’s practice for a possible Hyaluronidase treatment.

Transparency of risks and costs

Thanks to many years of experience with HA and Hyaluronidase, Dr. Eva Maria Strobl provides her patients with comprehensive advice on all the effects and side effects of Hyaluronidase treatment. Since its use is not without risk, she places great emphasis on patient education and discussion of possible alternatives. She is also, of course, completely transparent regarding the cost of the treatment.

Learn more about dissolving HA-filler with Hyaluronidase at LIPS and SKIN in Munich on this page.

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All important facts about Hyaluronidase in a nutshell

Hyaluronidase at a Glance

Duration:30-45min incl. consultation and allergy test
Effect sets in:immediately, full effect within 24 hours
Anaesthesia:usually not necessary, if desired locally
Risks:allergic reaction; aesthetically adverse effect in case of overdose.
Cost:from approx. €190
The price quoted above is indicative only. Actual costs of treatment are calculated and charged according to the German Medical Fee Schedule (GOÄ).
Competence in hyaluronic acid filler dissolving with Hyaluronidase

Your benefits with dr. Strobl

quality thanks to specialization

Several years of experience with Hyaluronidase

Sufficient time and full attention on patients

A relaxed atmosphere in a central location in Munich

Direct accessibility via cell phone and e-mail in aftercare

Fair calculated Treatment cost

The enzyme Hyaluronidase, commercially branded “Hylase” in Germany

What is Hyaluronidase?

In Germany, medical grade Hyaluronidase is marketed under the trade name “Hylase”. The enzyme Hyaluronidase is naturally found in the human body. It splits hyaluronic acid into its individual molecular fragments, thereby loosening the tissue. The process, which is part of normal tissue regeneration in the body, enables more rapid absorption of injected agents in medicine. The primary use of the drug Hylase has long been in surgical ophthalmology, where it increased the effectiveness of local anaesthesia.

Hyaluronidase in case of emergency and incorrect corrections

The possibility of cleaving hyaluronic acid with Hyaluronidase was later exploited in the event of complications or undesirable results following injections with hyaluronic fillers. This is one of the reasons why hyaluronic acid has become the treatment of choice for wrinkles – because it is the only filler material for which an antidote in the form of Hyaluronidase is available. Therefore, for reasons of patient safety alone, it is not missing in any medical practice that administers hyaluronic acid fillers and takes complication management seriously. Although serious complications are fortunately rare after FA-filler treatments by competent medical professionals, they can be dramatic if they happen. In a worst-case scenario, a misplaced HA-filler injection can lead to occlusion of an arterial vessel, which, if left untreated, results in tissue destruction (necrosis). Complete and fast dissolving of the blockage with Hyaluronidase is the only viable emergency procedure in such a case. Outside emergencies, Hyaluronidase can also be used to neutralize any incorrect correction with hyaluronic acid filler when the aesthetic result is not satisfactory.

Hylase harbours allergenic potential

The Hyaluronidase in the drug Hylase is obtained from bull testicles and may therefore contain small traces of bovine protein. Thus, in rare cases, allergic reactions accompanied by shock symptoms may occur after Hylase treatment. Therefore, the use in aesthetic medicine is not arbitrary, but should be limited to real emergencies and seriously failed aesthetic outcomes from filler injections.

Often it is better to wait for the HA-filler lifetime to elapse

When is Hyaluronidase Treatment useful?

Since the use of Hylase is not entirely without risk and hyaluronic acid fillers degrade after a few months anyway, corrective treatment with Hylase is not always advisable. In the case of smaller or visually less disturbing imperfections, it is usually advisable to simply wait for the filler to last.

Also regarding Hylase costs, patients can only be advised to do so. At least 2 x 1ml Hylase with 150 units each are required for the complete dissolution of 1ml hyaluronic acid filler. In terms of price, this means at least €250 for the Hyaluronidase treatment or more. If you add these costs to those of a subsequent re-treatment with dermal filler, the complete package quickly becomes rather expensive.

Emergency and persistent swelling

Emergency use of Hylase is of course without alternative and should be routine for any practice performing HA-filler injections. Such an emergency does not have to be the occlusion of an arterial vessel, but may also consist of an inflammatory swelling that cannot be successfully treated by other means (e.g. corticosteroids). Such swellings occur particularly in sensitive facial areas such as the lacrimal groove. Of the cases corrected with Hyaluronidase in my practice in Munich, the majority affected this zone.

Aesthetically displeasing mismatches refer to noticeable swelling and asymmetric treatment results, often caused by the filler binding tissue fluid unevenly. Typically, they are also the result of incorrect procedure of injections. Such incorrect corrections are rare overall and mostly affect the sensitive region of the tear trough as well as the lips. Lip correction with Hylase is the main reason why patients from outside come into my practice to have the filler dissolved.

How long to wait with new Filler injections?

Those who have the undesirable result of a hyaluronic acid injection corrected with Hylase typically consider a new treatment with dermal filler in the near future. This raises the question of how long Hyaluronidase remains active in the tissue, which could counteract a new filler injection. The medical literature provides very different answers to this question, ranging from 2 to 3 days to 2 or 3 weeks. In all practical terms, the answer is, however, rather straightforward: as the so-called “half-life” of Hyaluronidase is in the range of only minutes, significant amounts cannot be active anymore as early as 1–2 days after treatment.

From consultation to allergy test and injection

The Treatment Process

Due to the allergenic potential of Hylase, and the possible side effects associated with it, I emphasize comprehensive consultation and risk disclosure before treatment. During the consultation, I also try to determine whether the application of Hylase is actually necessary, or whether the filler’s time-dependent absorption cannot be waited for instead. Finally, I check for an allergic reaction with a patch test on the patient’s forearm.

Cleaning, anaesthesia and injection

After thorough cleaning and disinfection of the treatment area, I apply an anaesthetic cream. This requires about 30 minutes of exposure time. Subsequently, the Hyaluronidase is injected with a thin hypodermic needle. Because Hylase does not contain lidocaine, unlike most dermal fillers, the injection may cause a marked burning sensation, despite topical anaesthesia. The dissolving effect of Hyaluronidase sets in immediately. Within 12 to 24 hours, hyaluronic acid filler is usually completely dissolved. The treatment lasts no longer than 45 minutes in total. Normally, one session is sufficient to completely dissolve all unwanted HA-filler in the tissue.

Rare allergic reactions after Hylase treatment

Are there any risks with Hylase?

Hylase is generally tolerated without problems, even in very high doses. However, due to the possible content of bovine proteins, allergic reactions cannot be completely ruled out. Therefore, it is important to disclose any known hypersensitivities to your practitioner before treatment. Your doctor should also be equipped with appropriate emergency equipment suitable for treating even a severe allergic reaction.

Undesirable aesthetic effect in case of overdosing

A treatment with Hyaluronidase affects previously injected filler as well as endogenous hyaluronic acid produced and stored in the tissue by the body. The enzyme makes no distinction in this regard. An overdose of Hyaluronidase can therefore cause the body’s own hyaluronic acid to be broken down. And this, in turn, can lead to an aesthetically unflattering loss of volume. Fortunately, such a side effect would only be of limited duration, as the body regenerates his hyaluronic acid deposits relatively quickly. Nevertheless, such a result can be visually unflattering for a few weeks and psychologically stressful. Therefore, to prevent overdose of Hyaluronidase, treatment should always be performed by experienced physicians only. In my own practice in Munich, I carefully dose or even underdose Hyaluronidase for purely aesthetic corrections. For complete dissolution, I start with about 300 units of Hylase per 1ml of hyaluronic acid to be dissolved. On the other hand, in true emergencies, especially vascular complications, I would proceed on a large scale and at very high doses of 3000 units or more.

Contraindications to Hyaluronidase treatment

When Must Hyaluronidase not be used?

Hyaluronidase must not be used on patients with:

  • known allergy to Hyaluronidase or bovine protein
  • congenital heart defect
  • acute infection in the treatment area
  • existing swellings due to stings or bites
  • presence of cancer
  • pregnancy from 28th week of gestation, before that only in case of emergency
  • baby who is breastfed

A history of allergic reactions to wasp or bee stings indicates an increased risk of allergic reaction to Hyaluronidase and should be considered a relative contraindication. The venom of stinging insects may contain Hyaluronidase and thus be the cause of sensitization in affected individuals.

Incidentally, the fact that Hyaluronidase must not be administered during pregnancy and breastfeeding is also a major reason why dermal filler treatments are ill-advised during this time. In the case of a severe complication, the only available antidote would not be available.

Filler volume to be dissolved drives Hyaluronidase cost

How much does the treatment cost?

The treatment costs depend on the type of intervention and the amount of Hyaluronidase used. This in turn depends on the volume of hyaluronic acid filler that is to be dissolved. In my practice in Munich, a Hyaluronidase treatment usually costs between €200 and €400, with the volumes of hyaluronic acid to be dissolved being between 1 and 2 ml. These prices are indicative. Actual treatment costs are billed according to the German Medical Fee Schedule (GOÄ).

Attractive at every age

LIPS and SKIN Aesthetic Medicine

Eva Maria Strobl, MD
Herzog-Heinrich-Strasse 34
80336 Munich